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Friday 22nd June 2018

Acute Service reconfiguration

16th February 2007

17082006_ambulanceinside1.jpgAs the Government presses ahead with its planned reforms to Acute Services we examine the arguments of the proponents of change, and the disquiet of those who may be affected.

1 What is planned?

In September 2006 the Government signaled its intention to press ahead with further changes to acute services. Dave Nicholson, the new NHS Chief Executive, told The Guardian that there will be ‘up to 60 reconfigurations of NHS services…. Some changes will try to squeeze out extra capacity that contributed to the NHS’ £512m deficit…But most will be aimed at redesigning the NHS to improve care by concentrating key services in fewer hospitals. ‘
These views have been publicly backed by Tony Blair and Patricia Hewitt. Both have indicated the Government’s clear intention to make changes in spite of the anticipated public outcry.

2 Why more reconfiguration?

The pressure for reconfiguration is coming from the growing recognition that services need to be delivered differently in the future. Two recent report, ‘Emergency Access’ by Sir George Alberti (the National Director for emergency access) and ‘Mending Hearts and Brains’ by Professor Richard Boyle (the National Director for heart disease) set out a clear case for creating specialist centres capable of providing the full range of emergency treatments. Both reports make the case for reconfiguring A&E services. Specialist centres would optimise care for the most serious cases, while local A&E departments would continue to treat most patients.

Alberti recognises that the some harsh realities will need to be faced. The public will need to understand that ‘some of the A&E departments that they cherish are not able to provide the degree of specialisation and specialist cover that modern medicine dictates’

3 So which services are most at risk?

So far the Government has not published a list of the health communities which are most likely to be affected by the reconfigurations. However David Nicholson has made it clear that the reconfigurations will ‘affect every SHA in the land’ and is most likely to impact on A&E, maternity and paediatric services. This is because:

 A&E services should be modernised so that better care can be provided to patients as described above. This is likely to lead to the development of ‘super A&Es’, for patients with the most serious conditions, local A&Es, for most patients and conditions, and travelling A&E services, to treat certain patients in their own home.

• Inpatient maternity services should be provided in hospitals which are able to provide a 24 hour consultant led service, 7 days a week. This requires services to be concentrated in a smaller number of hospitals with capacity to treat more patients. Patient choice will be maintained by providing midwife led services in some areas where there is sufficient demand.

• Paediatric services should also be concentrated in a smaller number of hospitals so that a 24/7 consultant led service can be provided.  Similarly dedicated paediatric A&E services will only be provided in hospitals which provide 24/7 consultant led paediatric service.

4 Which hospitals are likely to be affected?

Recently there has been significant debate about which hospitals are likely to be affected by these changes. In December 2006 the Conservative party published the following list of 29 A&E departments which they identified as being most at risk from plans to reorganise local services:

• Ashford and St Peter's Hospitals

• Barking, Havering and Redbridge NHS Trust

• Barnet and Chase Farm Hospitals NHS Trust

• Buckinghamshire Hospitals NHS Trust

• Calderdale and Huddersfield NHS Foundation Trust 

• East and North Hertfordshire NHS Trust

• East Sussex Hospitals NHS Trust

• Epsom and St Helier University Hospitals NHS Trust

• North Bristol NHS Trust

• George Eliot Hospital NHS Trust

• Good Hope Hospital NHS Trust, Sutton Coldfield

• Hinchingbrooke Health Care NHS Trust 

• North West London Hospitals NHS Trust 

• Oxford Radcliffe Hospitals NHS Trust

• Pennine Acute Hospitals Trust

• Princess Royal Hospital, Haywards Heath

• Queen Mary's Sidcup NHS Trust, Kent

• Royal Cornwall Hospitals NHS Trust

• Royal Free Hampstead NHS Trust

• Royal Surrey Hospital NHS Trust

• Royal West Sussex NHS Trust

• Sandwell and West Birmingham Hospitals NHS Trust 

• South Tees Hospitals NHS Trust 

• South Warwickshire General Hospitals NHS Trust 

• United Lincolnshire Hospitals Trust

• West Hertfordshire Hospitals Trust

• Whipps Cross University Hospital

• Whittington Hospital NHS Trust 

• Worthing and Southlands Hospitals NHS Trust

However this list does not appear to be accurate. At least 11 Trusts have denied that there are any plans to make changes, including Whittington Hospital NHS Trust, South Warwickshire General Hospitals NHS Trust, Buckinghamshire Hospitals NHS Trust and Oxford Radcliffe Hospitals NHS Trust. Also some Trusts, such as Maidstone & Tunbridge Wells NHS Trust and East Lancashire NHS Trust, which already have plans for change are not listed.

5 So is this just about saving money?

Many people suspect that these changes are being driven solely by the need to save money. However as Patricia Hewitt is at pains to point out ‘….people think it is all about saving money, and it isn’t. It’s about saving more people’s lives; it’s about making care more convenient. It’s about getting the money into the right place so that people get the best care from the right person at the right time.’

Similarly Alberti also concludes that ‘Finances…are not the reason for reform. Reforming emergency care is about responding to medical advances and providing new and better services in ways that allow the NHS to save more lives.’

6 Who is concerned about the proposed changes?

There is significant concern about these reconfigurations. Both the Government and health professionals recognise the difficulties of convincing the public that change will be beneficial.
At least 13 labour MPs including senior ministers, are campaigning against service changes in their constituencies, inspite of the Government’s explicit intention to back change. Prominent protesters include:

• Health minister Ivan Lewis is campaigning to save the maternity unit at Fairfield Hospital in Bury.

• Chairwoman Hazel Blears is campaigning to retain maternity services at Hope Hospital, Salford.

• Culture Secretary Tessa Jowell & Solicitor General Harriet Harman are opposing the closure of Maudsley Emergency Centre.

• Home Secretary John Reid is supporting the campaign to stop the closure of A&E at Monklands Hospital, Ardrie.

• Chief Whip Jacqui Smith to save maternity services in Redditch.

A number of vociferous campaigning groups have already been established to protect services in areas where health reviews are ongoing.




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